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*For medical professionals to read for reference, how to choose immune-targeted therapy for patients with advanced renal cancer? How effective is the combination therapy? Clarify it in one article! At present, the drug treatment of advanced renal cancer has entered a new era of targeted therapy.
Is the neoadjuvant treatment of targeted drugs effective for renal cancer patients before surgery? What are the alternative drugs for preoperative neoadjuvant therapy? Targeted drugs and immune drugs, how should patients with renal cell carcinoma choose? How to realize the whole-process management and precise diagnosis and treatment of patients with advanced kidney cancer? This time, the Medical Oncology Channel invited Professor Qiao Baoping, Director of the First Affiliated Hospital of Zhengzhou University, Professor Zhang Zhengyu, Director of Urology, Eastern Theater General Hospital, and Professor Xiao Jun, Director of Urology, First Affiliated Hospital of University of Science and Technology of China, to discuss the targeting of kidney cancer patients.
Medication related issues
.
At present, targeted drug therapy for renal cancer can be divided into three types: 1.
Advanced renal cancer drug therapy: patients with advanced inoperable renal cancer, use targeted drug therapy
.
2.
Adjuvant drug treatment: use drugs to maintain the treatment of patients with early renal cancer after surgery
.
3.
Neoadjuvant treatment: preoperative drug treatment for patients with inoperable kidney cancer to shrink the tumor to be resectable
.
What are the alternative targeted drugs for neoadjuvant therapy of kidney cancer? For kidney cancer, targeted drugs can be the first choice for neoadjuvant therapy.
Professor Xiao Jun believes that for advanced or locally advanced kidney cancer, if the patient’s tumor has broken through the kidney’s capsule or there is an inferior vena cava tumor thrombus, and the lesion Over 10cm, targeted therapy can be selected
.
The choice of targeted drugs is mainly TKI, such as pezopanib, everolimus and so on
.
Generally, the duration of drug use is 1 to 3 months, and the degree of tumor control needs to be dynamically monitored.
If obvious control is obtained, cytoreductive or radical surgery can be considered
.
Targeting and immunity, how should patients with renal cell carcinoma choose? At present, advanced renal cell carcinoma has entered the era of targeted therapy and immunotherapy.
Both immunity and targeting have become the first-line choice for renal cell carcinoma
.
As for how to choose a treatment plan for patients with renal cancer, Professor Qiao Baoping believes that the selection is mainly based on the stratification results of the International Metastatic Renal Cell Carcinoma Combined Database (IMDC) prognostic scoring model
.
Single-use targeted drugs in low-risk patients, single-risk patients with intermediate-risk factors, and patients with good physical status are similar to combination drugs in overall survival (OS) or progression-free survival (PFS)
.
Combination therapy does not show obvious advantages, but treatment costs and adverse reactions have increased.
Therefore, for this type of patients, whether it is the Chinese Society of Clinical Oncology (CSCO) guidelines or the National Comprehensive Cancer Network (NCCN) guidelines, both Single-agent therapy with targeted drugs is recommended
.
However, for patients with intermediate to high-risk renal cancer with more than two risk factors, clinical results show that targeted combined immunotherapy shows greater advantages.
However, there are currently no approved indications for advanced renal cancer in China for immunotherapy, so it is still Focus on targeted therapy
.
Speaking of immunotherapy for kidney cancer, Professor Zhang Zhengyu believes that immunotherapy has not yet been approved for relevant indications, and we still need to further explore the immunotherapy of tumors
.
Clinically, when doctors need to administer super-indication drugs to patients, they need the patient’s informed consent and the approval of the ethics committee
.
How to achieve full management and precise layout? At present, for patients with advanced renal cancer, the drugs available in China are pezopanib, everolimus, sunitinib, axitinib and sorafenib
.
Other drugs are also recommended in the CSCO and NCCN guidelines, such as temsirolimus, nivolumab, lenvatinib, cabotinib, pembrolizumab, ipilimumab, etc.
.
The treatment options in the guidelines include targeted immunization combination and dual immunization combination
.
Professor Qiao Baoping mentioned that ultimately it is necessary to guide the choice of drugs according to the patient's immune expression and angiogenesis status
.
For example, patients with high angiogenin levels can choose anti-angiogenesis drugs, patients with positive gene testing for driving genes can use targeted drugs, patients with weakened immune systems can use immune drugs, or combined drugs based on the patient's condition
.
Professor Zhang Zhengyu mentioned: “In the past, the idea of medication was that after TKI resistance, sequential treatment may replace mTOR inhibitors, and choose drugs with completely different mechanisms in principle
.
The idea now is that after a targeted drug is resistant, Another targeted drug can be tried in the second line
.
” When referring to the full management of kidney cancer patients, Professor Xiao Jun shared, “If patients can use targeted drugs in the first-line treatment, I would prefer targeted drugs
.
After the
patients progress, they need to For genetic testing and pathological testing, if targeted drug therapy is available, the second line will still use targeted drug sequential therapy
.
If the test results suggest that you need to choose drugs other than the indications, you must communicate with the patient in advance.
The reasons for choosing such drugs will be explained clearly
.
"Professor Baoping Qiao, Chief Physician, Second-level Professor, and Doctoral Supervisor of the First Affiliated Hospital of Zhengzhou University, Ph.
D.
graduated from Shanghai Fudan University School of Medicine, Chinese Medical Association Henan Urology Association Standing Committee Member of Henan Anticancer Association Endoscopy and Robotic Urology Chairman of the Surgery Professional Committee Vice Chairman of the Urology Branch of Henan Medical Association Vice Chairman of Zhengzhou Urology Society Deputy Chairman of the National Natural Science Foundation of China Ministry of Medical Sciences Tumor I Discipline Evaluation Committee Ministry of Education Degree and Graduate Education Development Center Paper Review Expert Peking University Books Zhang Zhengyu, director of the Department of Urology, Chief Physician, Master of Medicine, Professor, Master of the Second Military Medical University, and post-doctoral tutor of the Second Military Medical University The former deputy director of the Chinese Society and the Jiangsu Urology Branch of the Chinese Medical Association has long been engaged in clinical, teaching and scientific research in urology.
He is proficient in the clinical diagnosis and treatment of urinary system and male reproductive system infections, tumors and stones, and is familiar with related academic developments in urology.
Dynamic
.
Good at diagnosis and treatment of urinary and male reproductive system tumors, proficient in urological and minimally invasive surgical techniques, and diagnosis of male sexual dysfunction, urinary and male reproductive system congenital malformations, and urodynamic disorders He has a more in-depth research on treatment and treatment
.
Professor Xiao Jun, Director of Urology, Chief Physician, Doctor of Medicine, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Doctoral Supervisor, Chinese University of Science and Technology, Postdoctoral Workstation Supervisor, Chinese Medical Doctor Association Urology Branch Committee Member, China Member of the Anti-Cancer Association Urinary Male Reproductive System Tumor Professional Committee Member of the Standing Committee of the Prostate Cancer Expert Committee of the Chinese Society of Clinical Oncology (CSCO) Deputy Chairman of the Urology Branch of the Anhui Medical Association Deputy Chairman of the Urology Branch of the Anhui Medical Association Vice Chairman of the Anhui Anticancer Association Urology Male Vice Chairman of Reproductive Oncology Major, Vice Chairman of Anhui Andrology Branch, is good at various minimally invasive surgery and full management of urogenital and male reproductive system tumors
.
Presides over National Natural Science Foundation of China, Provincial Key Research and Development Program Project, Provincial Natural Science Foundation of China More than 10 SCI papers have been published
.
*This article is only used to provide scientific information to medical professionals and does not represent the views of this platform
Is the neoadjuvant treatment of targeted drugs effective for renal cancer patients before surgery? What are the alternative drugs for preoperative neoadjuvant therapy? Targeted drugs and immune drugs, how should patients with renal cell carcinoma choose? How to realize the whole-process management and precise diagnosis and treatment of patients with advanced kidney cancer? This time, the Medical Oncology Channel invited Professor Qiao Baoping, Director of the First Affiliated Hospital of Zhengzhou University, Professor Zhang Zhengyu, Director of Urology, Eastern Theater General Hospital, and Professor Xiao Jun, Director of Urology, First Affiliated Hospital of University of Science and Technology of China, to discuss the targeting of kidney cancer patients.
Medication related issues
.
At present, targeted drug therapy for renal cancer can be divided into three types: 1.
Advanced renal cancer drug therapy: patients with advanced inoperable renal cancer, use targeted drug therapy
.
2.
Adjuvant drug treatment: use drugs to maintain the treatment of patients with early renal cancer after surgery
.
3.
Neoadjuvant treatment: preoperative drug treatment for patients with inoperable kidney cancer to shrink the tumor to be resectable
.
What are the alternative targeted drugs for neoadjuvant therapy of kidney cancer? For kidney cancer, targeted drugs can be the first choice for neoadjuvant therapy.
Professor Xiao Jun believes that for advanced or locally advanced kidney cancer, if the patient’s tumor has broken through the kidney’s capsule or there is an inferior vena cava tumor thrombus, and the lesion Over 10cm, targeted therapy can be selected
.
The choice of targeted drugs is mainly TKI, such as pezopanib, everolimus and so on
.
Generally, the duration of drug use is 1 to 3 months, and the degree of tumor control needs to be dynamically monitored.
If obvious control is obtained, cytoreductive or radical surgery can be considered
.
Targeting and immunity, how should patients with renal cell carcinoma choose? At present, advanced renal cell carcinoma has entered the era of targeted therapy and immunotherapy.
Both immunity and targeting have become the first-line choice for renal cell carcinoma
.
As for how to choose a treatment plan for patients with renal cancer, Professor Qiao Baoping believes that the selection is mainly based on the stratification results of the International Metastatic Renal Cell Carcinoma Combined Database (IMDC) prognostic scoring model
.
Single-use targeted drugs in low-risk patients, single-risk patients with intermediate-risk factors, and patients with good physical status are similar to combination drugs in overall survival (OS) or progression-free survival (PFS)
.
Combination therapy does not show obvious advantages, but treatment costs and adverse reactions have increased.
Therefore, for this type of patients, whether it is the Chinese Society of Clinical Oncology (CSCO) guidelines or the National Comprehensive Cancer Network (NCCN) guidelines, both Single-agent therapy with targeted drugs is recommended
.
However, for patients with intermediate to high-risk renal cancer with more than two risk factors, clinical results show that targeted combined immunotherapy shows greater advantages.
However, there are currently no approved indications for advanced renal cancer in China for immunotherapy, so it is still Focus on targeted therapy
.
Speaking of immunotherapy for kidney cancer, Professor Zhang Zhengyu believes that immunotherapy has not yet been approved for relevant indications, and we still need to further explore the immunotherapy of tumors
.
Clinically, when doctors need to administer super-indication drugs to patients, they need the patient’s informed consent and the approval of the ethics committee
.
How to achieve full management and precise layout? At present, for patients with advanced renal cancer, the drugs available in China are pezopanib, everolimus, sunitinib, axitinib and sorafenib
.
Other drugs are also recommended in the CSCO and NCCN guidelines, such as temsirolimus, nivolumab, lenvatinib, cabotinib, pembrolizumab, ipilimumab, etc.
.
The treatment options in the guidelines include targeted immunization combination and dual immunization combination
.
Professor Qiao Baoping mentioned that ultimately it is necessary to guide the choice of drugs according to the patient's immune expression and angiogenesis status
.
For example, patients with high angiogenin levels can choose anti-angiogenesis drugs, patients with positive gene testing for driving genes can use targeted drugs, patients with weakened immune systems can use immune drugs, or combined drugs based on the patient's condition
.
Professor Zhang Zhengyu mentioned: “In the past, the idea of medication was that after TKI resistance, sequential treatment may replace mTOR inhibitors, and choose drugs with completely different mechanisms in principle
.
The idea now is that after a targeted drug is resistant, Another targeted drug can be tried in the second line
.
” When referring to the full management of kidney cancer patients, Professor Xiao Jun shared, “If patients can use targeted drugs in the first-line treatment, I would prefer targeted drugs
.
After the
patients progress, they need to For genetic testing and pathological testing, if targeted drug therapy is available, the second line will still use targeted drug sequential therapy
.
If the test results suggest that you need to choose drugs other than the indications, you must communicate with the patient in advance.
The reasons for choosing such drugs will be explained clearly
.
"Professor Baoping Qiao, Chief Physician, Second-level Professor, and Doctoral Supervisor of the First Affiliated Hospital of Zhengzhou University, Ph.
D.
graduated from Shanghai Fudan University School of Medicine, Chinese Medical Association Henan Urology Association Standing Committee Member of Henan Anticancer Association Endoscopy and Robotic Urology Chairman of the Surgery Professional Committee Vice Chairman of the Urology Branch of Henan Medical Association Vice Chairman of Zhengzhou Urology Society Deputy Chairman of the National Natural Science Foundation of China Ministry of Medical Sciences Tumor I Discipline Evaluation Committee Ministry of Education Degree and Graduate Education Development Center Paper Review Expert Peking University Books Zhang Zhengyu, director of the Department of Urology, Chief Physician, Master of Medicine, Professor, Master of the Second Military Medical University, and post-doctoral tutor of the Second Military Medical University The former deputy director of the Chinese Society and the Jiangsu Urology Branch of the Chinese Medical Association has long been engaged in clinical, teaching and scientific research in urology.
He is proficient in the clinical diagnosis and treatment of urinary system and male reproductive system infections, tumors and stones, and is familiar with related academic developments in urology.
Dynamic
.
Good at diagnosis and treatment of urinary and male reproductive system tumors, proficient in urological and minimally invasive surgical techniques, and diagnosis of male sexual dysfunction, urinary and male reproductive system congenital malformations, and urodynamic disorders He has a more in-depth research on treatment and treatment
.
Professor Xiao Jun, Director of Urology, Chief Physician, Doctor of Medicine, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Doctoral Supervisor, Chinese University of Science and Technology, Postdoctoral Workstation Supervisor, Chinese Medical Doctor Association Urology Branch Committee Member, China Member of the Anti-Cancer Association Urinary Male Reproductive System Tumor Professional Committee Member of the Standing Committee of the Prostate Cancer Expert Committee of the Chinese Society of Clinical Oncology (CSCO) Deputy Chairman of the Urology Branch of the Anhui Medical Association Deputy Chairman of the Urology Branch of the Anhui Medical Association Vice Chairman of the Anhui Anticancer Association Urology Male Vice Chairman of Reproductive Oncology Major, Vice Chairman of Anhui Andrology Branch, is good at various minimally invasive surgery and full management of urogenital and male reproductive system tumors
.
Presides over National Natural Science Foundation of China, Provincial Key Research and Development Program Project, Provincial Natural Science Foundation of China More than 10 SCI papers have been published
.
*This article is only used to provide scientific information to medical professionals and does not represent the views of this platform
